Effect of autoclave induced low-temperature degradation on the adhesion energy between yttria-stabilized zirconia veneered with porcelain

Effects of sterilization, conditioning, and thermal aging on the retention of zirconia hybrid abutments: A laboratory study

OBJECTIVE

To investigate the effects of sterilization, conditioning method, and thermal aging on the retentive strength of two-piece zirconia abutments.

MATERIALS AND METHODS

In total, 128 stock zirconia abutments were divided into four groups (n = 32) according to the conditioning parameters: (A) air-abrasion using 50 μm alumina particles/1.0 bar, (B) 50 μm/2.0 bar, (C) 100 μm/1.0 bar, and (D) 100 μm/2.0 bar. All abutments were bonded onto titanium bases using DTK adhesive resin and stored in water bath (37°C) for 72 h. Each group was subdivided into two subgroups (n = 16), group 1 was disinfected, whereas group 2 followed disinfection and autoclave sterilization. Half of the specimens of each subgroup (n = 8) was directly subjected to the axial retention test (groups N), while the other half was first subjected to 150 days of thermocycling followed by retention test (groups T). Statistical analysis was performed with three-way ANOVA, additional statistical analysis was performed by using separate one-way ANOVAs followed by the Tukey's post-hoc test for post hoc pairwise comparisons among groups.

RESULTS

The highest median retention strength was recorded for group B2N (1390 N), whereas the lowest strength was recorded for group C1T (688 N). No significant interaction (p ≥ 0.05) was detected between the different variables; conditioning method, sterilization, and the thermal cycling regarding the effect on the resulting retention. However, the sterilization always showed a positive effect. Thermocycling presented an adversely significant effect only in the absence of sterilization (p < 0.05), with the exception of subgroups A. For the sterilized groups, thermocycling had no statistically significant effect on the retention.

CONCLUSION

Steam autoclaving increased the retention of hybrid zirconia abutments. DTK adhesive resin for two-piece zirconia abutments performed well after sterilization and thermocycling.

On the behaviour of zirconia-based dental materials: A review

Zirconia-based dental materials are extensively used in clinical practice due to their tooth-like appearance, biofunctionality, biocompatibility, and affordability. However, premature clinical failures of veneering porcelains raise a concern about their integrity. Extensive studies have been performed over a decade to resolve this issue, but it is challenging to reference all information effectively. A single source identifying the significance of potential parameters on material performance has not previously been available. An evidence-based meta-narrative review technique was used to review the characteristic parameters that can affect the overall behaviour of zirconia-based materials. Keywords were chosen to assess manuscripts based on scientific coherence with this paper's research objective. Online keyword searches were carried out on ScienceDirect, PubMed, and SAGE databases for relevant published manuscripts from year 1985-2020.261 out of 3170 identified manuscripts were included. A total of 10 parameters were identified and classified into the material, manufacturing, and geometric aspects. The effect of every parameter was reviewed on the performance of the material. A discrepancy in findings was observed and is attributed to the fact that there is no standard methodology. This review acts as a single source that summarizes various parameters' contribution to zirconia-based dental materials' performance. This review facilitates manufacturing improvements by accounting for every parameter's effect on overall performance.

Evaluating the efficiency of three methods to clean and disinfect screw- and cement-retained prostheses

STATEMENT OF PROBLEM

Screw- and cement-retained prostheses (SCRPs) may be contaminated during fabrication in a dental laboratory, leading to mechanical and biological complications related to the implant treatment. Studies that explored methods to efficiently and conveniently clean and disinfect SCRPs are sparse.

PURPOSE

The purpose of this clinical study was to compare the efficiency of 3 methods to remove contaminants and microorganisms present on the surface of an SCRP.

MATERIAL AND METHODS

Forty-eight 1-unit SCRPs fabricated in a dental laboratory were randomly divided into 3 groups: wiping, soaking, or ultrasonic cleaning. The presence of contaminants was determined by scanning electron microscopy, and microbial cells were cultured before and after treatment. Bacterial colony-forming units (CFUs) on the surface of the SCRPs and contamination density at the implant-abutment interface and emergence profile area were assessed. Statistical tests including ANCOVA were used to compare the efficiency of different methods before and after treatment (α=.05).

RESULTS

Significant differences in contamination density were noted during the treatment at the implant-abutment interface and at the emergence profile area in the 3 groups (P<.05), but no significant differences were observed in the number of CFUs (P>.05). There were significant differences among the 3 methods for cleaning efficiency both at the implant-abutment interface (P=.023) and the emergence profile area (P=.038). At the implant-abutment interface, the contamination density after treatment was lower in the ultrasonic cleaning group than that in the soaking group (P=.007), whereas at the emergence profile area, the contamination density after treatment was lower in the ultrasonic cleaning group than that in the wiping group (P=.019) and the soaking group (P=.048).

CONCLUSIONS

All 3 treatment methods reduced contaminants on the SCRP surface, but ultrasonic cleaning yielded the most favorable results. However, none of the methods provided additional disinfection for SCRPs previously disinfected by ozone and UV in a dental laboratory.

The Influence of an Ultrasonic Cleaning Protocol for CAD/CAM Abutment Surfaces on Cell Viability and Inflammatory Response In Vitro

BACKGROUND/AIM

To evaluate the effect of an ultrasonic cleaning and disinfection method for CAD/CAM abutment surfaces on cell viability and inflammatory response in vitro.

MATERIALS AND METHODS

Untreated and manually polished surfaces of CAD/CAM generated titanium and zirconia disks were randomly assigned, either to a 3-step ultrasonic cleaning and disinfection process (test: TiUF, TiPF, ZrUF, ZrPF) or to 30 sec steam cleaning (control: TiUS, TiPS, ZrUS, ZrPS). Pre-cleaning surface analyses using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and surface profilometry were performed. Human gingival fibroblasts (HGFs) were cultured on test and control specimens and subsequently examined for cell viability and inflammatory response. Expression of acute inflammatory cytokine interleukin (IL)-6 and vascular endothelial growth factor A (VEGFA) were assessed by means of RT-qPCR.

RESULTS

Cells on all specimens exhibited a satisfactory viability, indicating firm attachment. Cells on polished zirconia samples, cleaned by means of sonication (ZrPF), exhibited significantly higher viability than cells on the same material cleaned by steam (ZrPS), p=0.019. For all other three material/ surface treatment combinations (TiU, TiP, ZrU), no such difference was observed between the cleaning methods. The messenger ribonucleic acid (mRNA) levels of IL-6 and VEGFA were between 50 and 105% of that of the control cells on the non-toxic control surface. mRNA levels of IL-6 and VEGFA correlated well with each other.

CONCLUSION

Except for higher viability of cells cultured on polished zirconia specimens, no universally applicable advantage could be found for the ultrasonic cleaning procedure for zirconia and titanium abutment surfaces regarding cell viability, IL-6 expression or VEGFA expression. The cleaning procedures did not have any negative effect either.

Influence of a surface conditioner to pre-sintered zirconia on the biaxial flexural strength and phase transformation

OBJECTIVES

To assess the influence of a surface conditioner applied to pre-sintered yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) on the biaxial flexural strength and phase transformation.

METHODS

Conditioner-coated specimens (12mm diameter×0.8mm thickness) were prepared by application of a slurry conditioner using a brush on pre-sintered Y-TZP discs, followed by sandblasting with 50-μm Al₂O₃ after sintering (C-SB) or no further treatment (C-NT). The remaining conditioner-free specimens were subjected to sandblasting before sintering (NC-SB) or were maintained without treatment (NC-NT). Surface roughness measurements and scanning electron microscopy (SEM) in conjunction with energy dispersive X-ray spectroscopy (SEM-EDX) were performed for surface characterizations. The phase transformation of Y-TZP was identified by X-ray diffraction (XRD), and the biaxial flexural strength was measured using the piston-on-three-ball test according to ISO 6872:2015. The data were analyzed using nonparametric Kruskal-Wallis tests and Weibull distributions with the maximum likelihood estimation.

RESULTS

Sandblasting resulted in significantly rougher surfaces, irrespective of conditioner application. Conditioner layers were observed on surfaces in the C-NT and C-SB specimens. Monoclinic contents were present in a very small amount in the C-SB specimens. Both median biaxial flexural and characteristic strengths of all specimens exceeded ISO 6872:2015 requirements (Class 5: >800MPa), except the NC-SB specimens which showed significantly the lowest strength (p<0.001). Although no statistical difference was observed in Weibull modulus among the specimens (p=0.598), the NC-SB specimens showed the highest.

SIGNIFICANCE

Surface conditioner application does not affect the biaxial flexural strength and phase stability of Y-TZP and can be considered practical for clinical use.

On the bulk degradation of yttria-stabilized nanocrystalline zirconia dental implant abutments: an electron backscatter diffraction study

Degradation of yttria-stabilized zirconia dental implants abutments due to the tetragonal to monoclinic phase transformation was studied in detail by microstructural characterization using Electron Back Scatter Diffraction (EBSD). The amount and distribution of the monoclinic phase, the grain-size distribution and crystallographic orientations between tetragonal and monoclinic crystals in 3 mol.% yttria-stabilized polycrystalline zirconia (3Y-TZP) were determined in two different types of nano-crystalline dental abutments, even for grains smaller than 400 nm. An important and novel conclusion is that no substantial bulk degradation of 3Y-TZP dental implant abutments was detected after 1 year of clinical use.

Influence of sodalite zeolite infiltration on the coefficient of thermal expansion and bond strength of all-ceramic dental prostheses

In all-ceramic systems, a high incidence of veneer chip-off has been reported in clinical studies. Coefficient of thermal expansion (CTE) behaviour is one of the factors that may increase residual stress in the interface and influence the veneer/core bond strength. Therefore, this study aimed to evaluate the effect of sodalite zeolite-infiltration on the CTE behaviour and bond strength of different all-ceramic prostheses. The case-study groups were synthesized sodalite zeolite-infiltrated alumina (IA-SOD) and synthesized sodalite zeolite-infiltrated zirconia-toughened alumina (ZTA) (IZ-SOD), while the control groups were glass-infiltrated alumina (IA-glass) and glass-infiltrated ZTA (IZ-glass). Forty cylindrical-shaped samples measuring 5 mm in diameter and 10 mm in height were tested for CTE using a thermo-mechanical analyser machine, and forty disc-shaped ceramic samples measuring 12 mm in diameter and 1.2 ± 0.2 mm in thickness were prepared using specially designed stainless steel split mould and veneered by cylinder-shaped (2 mm high × 2 mm diameter) low-fusing porcelain (Vita VM7). The veneer/core samples were sintered and tested for shear bond strength using a high precision universal testing machine. Scanning electron microscope, stereo microscope, atomic force microscope, and energy-dispersive X-ray spectroscopy were used to investigate the structural characteristics of samples at the fracture surface. The collected data were analyzed with a one-way ANOVA and Tukey HSD test (α=.05). IZ-SOD revealed highest CTE and shear bond strength values, while the IA-glass revealed the lowest values than the other groups. There was no significant difference in CTE and bond strength among IZ-SOD, IA-SOD and IZ-glass samples (p>0.05). The experimental SOD zeolite-infiltrated samples revealed higher CTE mismatch and bond strength along with a more favourable mode of failure than did the commercial glass-infiltrated samples. Sandblast technique is considered as effective conditioning procedure for enhancing the surface roughness of SOD zeolite-infiltrated frameworks which subsequently improving the bond strength.

Porcelain bonding to novel Co-Cr alloys: Influence of interfacial reactions on phase stability, plasticity and adhesion

OBJECTIVE

The objective of the present study was to determine the hardness and adhesion strength at the porcelain to alloy interface.

METHODS

15 bi-layer porcelain veneered Co-Cr specimens of each alloy group [cast, powder metallurgy (PM), CAD/CAM(CC)] were manufactured. 12 bi-layered specimens were tested using four-point bend strain energy release rate adhesion test. One before and after porcelain firing specimen of each alloy group were nano-indented at the bulk and metal-porcelain interface to determine the mechanical properties. Electron backscatter diffraction was used to determine the microstructure and phase of the indented areas.

RESULTS

The results obtained from the four-point bend strain energy release rate test indicated highest adhesion energy of 92.15J/m² observed in the CC produced Co-Cr alloy. This was followed by the PM alloy with an adhesion energy of 62.24J/m² and cast alloy with an adhesion energy of 42.83J/m². All comparisons of adhesion energy between the three alloys were found to be statistically significant (p<.05). Nano-indentation test indicated higher hardness values of 4.6-6.1GPa at the metal-porcelain interface compared to the bulk, which had hardness values of 3.1-3.9GPa.

SIGNIFICANCE

The adhesion of the alloy to porcelain was found to be inversely related to the hardness of the interfacial layer at the alloy surface. Lower interfacial hardness was found to be accompanied with higher adhesion energy due to the additional plastic energy consumed during crack propagation along the more ductile interface region of the alloy.

Influence of the Conditioning Method for Pre-Sintered Zirconia on the Shear Bond Strength of Bilayered Porcelain/Zirconia

This study evaluated the bond strength of veneering porcelain with an experimental conditioner-coated zirconia. Pre-sintered Y-TZP specimens (n = 44) were divided in two groups based on conditioning type. After sintering, all sample surfaces were sandblasted and layered with veneering porcelain. Additionally, half of the specimens in each group underwent thermal cycling (10,000 cycles, 5–55 °C), and all shear bond strengths were measured. After testing, the failure mode of each fractured specimen was determined. Differences were tested by parametric and Fisher’s exact tests (α = 0.05). The differences in bond strength were not statistically significant. Adhesive fractures were dominantly observed for the non-thermal cycled specimens. After thermal cycling, the conditioner-coated group showed cohesive and mixed fractures (p = 0.0021), whereas the uncoated group showed more adhesive fractures (p = 0.0021). Conditioning of the pre-sintered Y-TZP did not change the shear bond strength of the veneering porcelain, but did improve the failure mode after thermal cycling.

Translucency of monolithic and core zirconia after hydrothermal aging

Objective: To evaluate the hydrothermal aging effect on the translucency of partially stabilized tetragonal zirconia with yttria (Y-TZP) used as monolithic or fully milled zirconia and of core type.

Methods: Twenty disc-shaped specimens (1 and 10 mm) for each type of monolithic and core Y-TZP materials were milled and sintered according to the manufacturer’s instruction. The final specimens were divided into two groups according to the type of Y-TZP used. Translucency parameter (TP) was measured over white and black backgrounds with the diffuse reflectance method; X-ray diffraction (XRD) and scanning electron microscope (SEM) were used to analyze the microstructure of both Y-TZP types before and after aging. Data for TP values was statistically analyzed using Student’s t-test.

Results: Monolithic Y-TZP showed the highest TP mean value (16.4 ± 0.316) before aging while core Y-TZP showed the lowest TP mean value (7.05 ± 0.261) after aging. There was a significant difference between the two Y-TZP types before and after hydrothermal aging. XRD analysis showed increases in monoclinic content in both Y-TZP surfaces after aging.

Conclusion: Monolithic Y-TZP has a higher chance to low-temperature degradation than core type, which may significantly affect the esthetic appearance and translucency hence durability of translucent Y-TZP.